BACKGROUND:Lifespan of prosthetic joint was being influenced by periprosthetic infection after total hip arthroplasty. Combination of debridement,antibiotics,and implant retention with the replacement of assembled components represents a novel approach in the management of acute prosthetic joint infection after total hip arthroplasty.OBJECTIVE:To observe the efficacy of debridement,antibiotics,and implant retention combined with the replacement of assembled components in the treatment of acute prosthetic joint infection after total hip arthroplasty.METHODS:Twenty-two patients with acute prosthetic joint infection after initial total hip arthroplasty at the Department of Orthopedics,Huangshi Central Hospital,China,between July 2018 and February 2022 were enrolled. The infection time of all patients was less than 3 weeks after the initial arthroplasty. Intraoperative joint fluid extraction and bacterial culture of infected synovium proved to be acute stage infection. They were treated using debridement,antibiotics,and implant retention combined with the replacement of assembled components. Infections were assessed using leukocyte count,erythrocyte sedimentation rate,and C-reactive protein levels before,3 and 6 months after surgery. Improvements in hip joint function were evaluated using Harris hip score. Pain relief was assessed using visual analog scale score. Paired sample t-test was used to analyze the improvement of each index before and after operation.RESULTS AND CONCLUSION:(1) One patient died of non-periprosthesis infection and was subsequently lost to follow-up,which was excluded. The remaining 21 patients received clinical follow-up,and the follow-up time was more than 1 year,with a mean follow-up time of (19.52±3.88) months. Among them,20 patients were successfully treated with surgery and 1 patient failed,and the infection control rate was 95％. (2) The levels of leukocyte count,erythrocyte sedimentation rate,and C-reactive protein were lower in 3 and 6 months after surgery (P<0.05);Harris hip function scores were higher than those before surgery (P<0.05);pain visual analog scale scores were lower than those before surgery (P<0.05),and the differences were significant (P<0.05). (3) It is indicated that debridement,antibiotics,and implant retention combined with the replacement of assembled components after total hip arthroplasty in patients with acute prosthetic joint infection can effectively control prosthetic joint infection,improve hip function,and relieve hip pain caused by infection.

BACKGROUND:Lifespan of prosthetic joint was being influenced by periprosthetic infection after total hip arthroplasty. Combination of debridement,antibiotics,and implant retention with the replacement of assembled components represents a novel approach in the management of acute prosthetic joint infection after total hip arthroplasty.OBJECTIVE:To observe the efficacy of debridement,antibiotics,and implant retention combined with the replacement of assembled components in the treatment of acute prosthetic joint infection after total hip arthroplasty.METHODS:Twenty-two patients with acute prosthetic joint infection after initial total hip arthroplasty at the Department of Orthopedics,Huangshi Central Hospital,China,between July 2018 and February 2022 were enrolled. The infection time of all patients was less than 3 weeks after the initial arthroplasty. Intraoperative joint fluid extraction and bacterial culture of infected synovium proved to be acute stage infection. They were treated using debridement,antibiotics,and implant retention combined with the replacement of assembled components. Infections were assessed using leukocyte count,erythrocyte sedimentation rate,and C-reactive protein levels before,3 and 6 months after surgery. Improvements in hip joint function were evaluated using Harris hip score. Pain relief was assessed using visual analog scale score. Paired sample t-test was used to analyze the improvement of each index before and after operation.RESULTS AND CONCLUSION:(1) One patient died of non-periprosthesis infection and was subsequently lost to follow-up,which was excluded. The remaining 21 patients received clinical follow-up,and the follow-up time was more than 1 year,with a mean follow-up time of (19.52±3.88) months. Among them,20 patients were successfully treated with surgery and 1 patient failed,and the infection control rate was 95％. (2) The levels of leukocyte count,erythrocyte sedimentation rate,and C-reactive protein were lower in 3 and 6 months after surgery (P<0.05);Harris hip function scores were higher than those before surgery (P<0.05);pain visual analog scale scores were lower than those before surgery (P<0.05),and the differences were significant (P<0.05). (3) It is indicated that debridement,antibiotics,and implant retention combined with the replacement of assembled components after total hip arthroplasty in patients with acute prosthetic joint infection can effectively control prosthetic joint infection,improve hip function,and relieve hip pain caused by infection.

Objective:To detect the expression of microRNA (miR)-211-5p, erythropoietin hepatocyte kinase receptor B2 (EphB2) and erythropoietin hepatocyte kinase ligand B2 (ephrin B2) in spinal cord tissues as well as nerve cells after spinal cord injury (SCI), and to explore their mechanisms and effects on neurological recovery in SCI rats.Methods:The study was conducted from May 2020 to June 2021 using Sprague Dawley (SD) rats and PC12 cells. SD rats were divided into sham-operated group and SCI group of 30 rats each, and Basso-Beattie-Bresnahan (BBB) score were performed at different postoperative time points (1, 3, 7, 14, 21 and 28 d), and the relative expression of miR-211-5p and Eph/ephrin B2 mRNA was measured by quantitative real-time polymerase chain reaction (qPCR); the SCI rats were divided into recombinant lentiviral vector LV-miR-211-5p group (group A), empty lentiviral vector LV-eGFP (group B) and saline group (group C), with 15 rats in each group, respectively. The recombinant lentiviral vector, empty lentiviral vector and saline were injected on the cephalic and caudal sides of the spinal cord injury, and the relative expression of miR-211-5p and Eph/ephrin B2 mRNA in the spinal cord tissue was measured at 1, 7 and 14 d after surgery. In addition, a PC12 injury cell line model was established with 150 μmol/L hydrogen peroxide (H 2O 2), and the apoptosis rate and apoptosis-related proteins and contents of different cell lines were detected by flow cytometry and Western blot, respectively. MiR-211-5p was verified to target EphB2 by dual luciferase reporter gene. Results:The results of the animal experiments showed that at different postoperative time points, the miR-211-5p levels in the SCI group were lower than those in the SHAM group: 0.70 ± 0.03 vs. 1.00 ± 0.10, 0.60 ± 0.04 vs. 1.00 ± 0.05, 0.45 ± 0.10 vs. 1.00 ± 0.12, 0.30 ± 0.06 vs. 1.00 ± 0.15, 0.20 ± 0.05 vs. 1.00 ± 0.13, 0.10 ± 0.02 vs. 1.00 ± 0.07. In contrast, levels of Eph/ephrin B2 were higher in the SCI group compared to the SHAM group: 1.10 ± 0.05 vs. 1.00 ± 0.01, 1.80 ± 0.01 vs. 1.00 ± 0.08, 2.30 ± 0.01 vs. 1.00 ± 0.10, 2.60 ± 0.01 vs. 1.00 ± 0.05, 2.80 ± 0.01 vs. 1.00 ± 0.06, 3.00 ± 0.01 vs. 1.00 ± 0.07 and 1.20 ± 0.05 vs. 1.00 ± 0.02, 1.60 ± 0.01 vs. 1.00 ± 0.03, 2.10 ± 0.10 vs. 1.00 ± 0.01, 2.40 ± 0.11 vs. 1.00 ± 0.09, 2.70 ± 0.13 vs. 1.00 ± 0.05, 2.90 ± 0.12 vs. 1.00 ± 0.03 ( P<0.05). At 14 d after surgery, Group A exhibited higher BBB scores than Groups B and C: (14.0 ± 1.1) points vs. (8.0 ± 1.1) and (8.2 ± 1.2) points, while miR-211-5p levels were higher than those in Groups B and C: 1.90 ± 0.10 vs. 0.40 ± 0.01 and 0.50 ± 0.02, and Eph/ephrin B2 levels were lower than those in Groups B and C: 0.70 ± 0.10 vs. 1.80 ± 0.04 and 1.90 ± 0.06, 0.60 ± 0.03 vs. 2.00 ± 0.04 and 2.10 ± 0.05 ( P<0.05). Immunofluorescence staining showed that the levels of GAP-43 and synaptophysin in group A were higher than those in groups B and C at 14 d after surgery ( P<0.05). Cellular assays showed that overexpression of miR-211-5p inhibited the apoptosis rate of H 2O 2-induced PC12 cells and the expression of the apoptosis-related gene Cleaved-caspase3 ( P<0.05). Knockdown of miR-211-5p increased the apoptosis rate of H 2O 2-induced PC12 cells and the expression of the apoptosis-related gene Cleaved-caspase3 ( P<0.05). Dual luciferase reporter gene assay confirmed that EphB2 was a target gene of miR-211-5p and overexpression of EphB2 antagonized the inhibitory apoptosis effect of miR-211-5p on H 2O 2-induced PC12 cells. Conclusions:This study showed that miR-211-5p could promote neurological repair in SCI by inhibiting the expression of Eph/ephrin B2 signaling pathway, suggesting that using miR-211-5p as a target to inhibit Eph/ephrin B2 signaling pathway may have a protective effect on SCI.

Objective To investigate the effect of arthroscopic arthroplasty on the short-term efficacy and stress factors in patients with primary osteoarthritis of the elbow and to guide the clinical application.Methods From February 2013 to February 2016,32 patients with primary primary osteoarthritis of the elbow underwent arthroscopic arthroplasty in Xiaogan Hospital Affiliated to Wuhan University of Science and Technology.The levels of serum TNF-α,IL-6,IL-10,adrenocorticotrophic hormone(ACTH) and other stress factors were measured before and after the operation.The ROM,MEPS and VAS were used to evaluate the curative effect before,3 months and 6 months after operation.Results All patients were followed up successfully.The excellent rate was 96.9%(31/32) 1 year after the operation.Preoperative ROM,MEPS score,VAS score were (83.2±18.6) °,(63.2±14.5) points,(3.2±1.8) points;3 months,6 months postoperative ROM were (102.3±18.9) °,(124.3±15.4) °,and MEPS scores were (75.4±16.8) points and (89.5±14.3) points respectively,which were significantly higher than those before operation (ROM F value of 43.19,P<0.001;MEPS F value of 23.86,P<0.001).Three months,6 months postoperative VAS scores were (0.5±0.2) points and (0.3±0.1) points,which was significantly decreased(76.55,P<0.001);preoperative TNF-α,IL-6I,L-10,ACTH were respectively (12.5±2.5) μg/L,(5.4±2.3) ng/L,(10.5±4.0) ng/L,(22.4±6.3) ng/L,and were (38.4±8.6) μg/L,(25.6±8.4) ng/L,(23.1±4.8) μg/L,(58.6 ± 15.0) μg/L 1 day after surgery,which significantly increased compared with preoperative levels(P<0.05);1 week after patient TNF-α,IL-10 were respectively (9.4±1.2) μg/L,(7.5±3.5) ng/L,which decreased significantly(P<0.001).IL-6,ACTH were respectively (3.1±0.9) μg/L,(19.5±5.8) ng/L,which showed no significant difference(P>0.05).Conclusion For the modest primary osteoarthritis of the elbow,arthroscopy arthroplasty can achieve good therapeutic effect,improve the patient′s motor function and life quality,and minimally invasive surgical approach is conducive to relieve systemic stress.

Objective To study the clinical efficacy and safety of posterior laminoplasty combined with foraminotomy in the treatment of mixed cervical spondylosis.Methods A total of 70 patients with mixed type cervical spondylosis from January 2012 to January 2014 in our hospital were randomly divided into observation group and control group.Patients in observation group received posterior laminoplasty com-bined with foraminotomy,and patients in control group received anterior cervical discectomy and fusion surgery.The operation time,intraoper-ative blood lossing,postoperative JOA scores and NDI scores between two groups were compared.The cervical curvature and range of motion were measured by X-ray.Results There was no significant difference in postoperative JOA scores,cervical curvature and range of motion be-tween two groups(P >0.05).The operative time and intraoperative blood loss of observation group was less than those of control group,the difference was no significance.The NDI scores of carrying and drive in observation group were higher than those in control group,while the NDI scores of other items between two groups had no significant difference(P >0.05).The incidence of complications in observation group was 10.81% (4 /37),the control group was 24.42% (8 /33),the difference between two groups was statistically significant,(χ2 =3.428, P <0.05).Conclusion The posterior laminoplasty combined with foraminotomy have good clinical effect for mixed type cervical spondylosis with advantages of a shorter operation time,simple operation,less intraoperative bleeding,lower incidence of complications,which is a kind of safe and effective surgical method.

BACKGROUND:For vertebral compression fractures treated by bal oon vertebroplasty, there were stil controversies in biomechanical and clinical studies about adjacent vertebral fractures is the result of osteoporosis progress, or the result of vertebral intervention and strengthening by injecting bone cement. More accurate conclusions can be obtained through more in-depth research and long-term fol ow-up. OBJECTIVE:To evaluate the effect of bal oon vertebroplasty on biomechanical properties of vertebral body with compression fractures and unstrengthened adjacent vertebral body. METHODS:Total y 40 pig specimens with vertebral compression fractures were prepared and randomly divided into study and control groups. Specimens in the study group were subjected to bal oon vertebroplasty. Specimens in the control group only wrapped with normal saline gauze. The biomechanical properties (vertebral height, maximum load), stress, strain and displacement values of specimens under 500 N loading in these two groups were compared. The stress and strain values of unstrengthened adjacent vertebral body before and after the bal oon vertebroplasty in the study group were measured, and compared with the control group. RESULTS AND CONCLUSION:Compared with the original height, specimens in the study group can restore to its original height after bal oon vertebroplasty, the differences were not significant (P>0.05). The former, back, left and right vertebral height in the study group were significantly higher than those in the control group (P<0.01). After the bone cement augmentation, the stiffness of vertebral body in the study group was significantly lower than that in the control group, the maximum loading was significantly increased compared with that in the control group (P<0.05). Under a fixed loading of 500N, compared with the control group, the disc displacement value after the bal oon vertebroplasty was significantly reduced and the disc strain and stress values were significantly increased in the study group (P<0.05). There were no significant differences in the strain and stress values of the unstrengthened adjacent vertebral body before and after the bal oon vertebroplasty in the study group (P>0.05). There were no significant differences in the strain and stress values of the unstrengthened adjacent vertebral body after the bal oon vertebroplasty between study group and control group (P>0.05). These results suggest that vertebral maximum loading and stiffness recover wel after the treatment of bal oon vertebroplasty for vertebral compression fractures, which can achieve the effect of preventing vertebral fractures again. Meanwhile, bal oon vertebroplasty treatment can not alter the biomechanical properties of adjacent vertebrae, and it is difficult to influence and lead vertebral fractures again, with a better security.

Objective To investigate the expression of Foxo3a in the lumbar dorsal root ganglia (DRG) after sciatic nerve injury in rats. Methods Forty-two adult rats were randomly divided into control group and experimental group. Rats in experimental group were subjected to sciatic nerve clamp. Expression and distribution of Foxo3a, growth associated protein (CAP) and axon regeneration in DRC were detected by Western blot and immunofluorescent staining. Results (1) After sciatic nerve injury, Foxo3a protein levels began to reduce at day 1, reached the lowest level at day 2 and then gradually rose to nomal level at four weeks after sciatic nerve injury. Proliferating cell nuclear antigen (PCNA) and GAP-43 were up-regulated from day 2, and the level of PCNA reached peak at day 7 after sciatic nerve injury in DRC. (2) Down-regulation of Foxo3a was observed predominantly in neurons and glial cells. PCNA mostly expressed in glial cells and hardly in neurons. Conclusion Down-regulation of Foxo3a in lumbar DRG may correlate with axonal regeneration and the proliferation of glial cells after sciatic nerve injury.